Clomiphene citrate for ovulation inducation in patients with polycystic ovarian sndrome

To provide fertility assistance and to determine the response of clomiphene citrate in polycystic ovarian syndrome. Observational study. Department of Obstetrics and Gynecology Lady Willingdon Hospital Lahore. Eighty-four patients of polycystic ovarian syndrome who required fertility assistance were subjected to clomiphene citrate therapy for duration of 12 months from February 2005 to January 2006. Clomiphene citrate [50-150mg] was administered from second to sixth day of menstrual cycle and TVS performed on 12th and 16th day of cycle for follicular growth, ovulation, endometerial thickness and echogenic pattern. Ovulation, conception rate, miscarriage rate and ovarian hyperstimulation rate were assessed. In addition the thickness and echogenic pattern of the endometrium was observed in conceived group. Forty-six patients [54.76%] ovulated in six cycles while twenty-seven [32.14%] remained anovulatory. Sixteen women [34.79%] conceived during the study period. Out of which ten women [62.5%] miscarried. Endometerial thickness did not differ [P>.50] between the conceived and non-conceived group but echogenic grade A pattern [75%] was observed during the conceived cycles [P<. 001]. Clomiphene citrate [CC] is a successful drug for ovulation induction in patients with polycystic ovarian syndrome. But the discrepancy in ovulation and pregnancy rate s upport that clomiphene citrate therapy has antiestrogenic effect at the endometrium, which interferes with implantation of pregnancy. The high miscarriage rate in these patients demand some other forms of therapies. These include weight reduction, use of insulin sensitizing drugs, gonadotrophin therapy and ovarian drilling to reduce high LH levels, thus correcting disturbed hormonal milieu, ovulation resumption and pregnancy outcome

Primary post partum haemorrhage: outcome of different treatment measures

This study was carried out to compare the efficacy and safety of different therapeutic measures used for controlling primary postpartum haemorrhage [PPH]. The venue of this work was the Department of Obstetrics and Gynaecology Lady Willingdon Hospital Lahore over a period of six months from July 1, 2005 - December 31, 2005. Fifty patients of primary PPH were recruited in this study. After identifying the risk factors for primary PPH thorough history, examination and investigations, these patients were treated medically and surgically to control haemorrhage. Control of bleeding by different measures was secured for the survival of patients. Medical intervention included use of oxytocins, and prostaglandins. Different surgical procedures like manual removal of placenta, suturing of genital tract tears, bimanual uterine compression and packing, stepwise devascularization and caesarean hysterectomy were done. Results of different procedures were analysed by using research proforma. The results show that out o f fifty, fifteen [30%] were booked patients. The major predisposing factor was grand multiparity in twenty-five [50%] patients. The predominant cause was uterine atony in thirty [60%] cases. Twenty [66%] patients were completely cured by different oxytocins. Eight [16%] had manual removal of placenta and two [4%] required evacuation of retained products of conception. Nine [18%] were treated by suturing the tears and lacerations. The commonest morbidity [66%] was anaemia. Mortality rate was 6%. In conclusion there is a need to reduce the alarmingly high maternal mortality and morbidity caused by primary PPH. Its main predisposing factors should be controlled. High parity, illiteracy and ignorance coupled with inadequate maternity services contribute towards this tragedy. If patients reach hospital well in time, effective management of obstetric haemorrhage should be prompt restoration of circulatory volume, accurate diagnosis of the cause of bleeding and early appropriate therapy to arrest the bleeding

Amnion graft in vaginoplasty: an Experience at 3 teaching hospitals of Lahore

This study was carried out to determine the outcome of vaginoplasty using amnion graft. It was conducted in 3 different hospitals of Lahore including Lady Willingdon hospital. Sir Ganga Ram hospital, and General hospital from March 2001 to March 2005. Ten patients with Mayer-Rokitansky -Kauster-Hauser syndrome [MRKH] included in the study, underwent vaginoplasty using amnion graft. All patients were followed upto 6 months and beyond to determine the outcome of vaginoplasty and coital function. The patients' age ranged between 18-30 years. Eight patients [80%] were married and two were unmarried. The procedure was uncomplicated in nine while one had rectal injury, which was repaired successfully before application of graft. Follow up ranged upto 6months and beyond. Eight patients had excellent vaginal depth upto 8cm after 6months. One patient had cicatrisation. One patient lost follow-up. Five had satisfactory coital function. Ammon graft vaginoplasty is an ideal, simpler method and provides good results n ot only in terms of improvement in vaginal length but also couple's satisfaction at coitus